GINA MICHELLE LUCKIANOW - Physician Assistant License in Pennsylvania | # 085002378

GINA MICHELLE LUCKIANOW

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002378

License Status

NOT RENEWED

Business

N

First Name

GINA

Middle

MICHELLE

Last Name

LUCKIANOW

Business Name

GINA MICHELLE LUCKIANOW

Original Issue Date

10/08/2004

Effective Date

10/08/2004

Expiration Date

03/01/2006

State

PA

Ever Disciplined

N

LastModifiedDate

10/09/2006